| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| JA BENEFITS LLC3 Filed as: JA BENEFITS, LLC | 1630 H STREET BEDFORD, IN 47421 | DELTA DENTAL OF INDIANA | $7K | — | $7K | 9.24% |
| JA BENEFITS LLC3 | PO BOX 159 BEDFORD, IL 47421 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $3K | — | $3K | 10.00% |
| JA BENEFITS LLC3 | 1630 H ST BEDFORD, IN 474213834 | UNITEDHEALTHCARE INSURANCE COMPANY | $992 | — | $992 | 9.22% |
| JA BENEFITS LLC3 | PO BOX 159 BEDFORD, IN 47421 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $86 | — | $86 | — |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC. EIN 35-0781558 NONE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Other fees; Claims processing; Float revenue Service code 12 | — | $149K |
| EXPRESS SCRIPTS, INC. EIN 31-1714795 NONE | Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Float revenue Service code 12 | — | $0 |
| JA BENEFITS LLC NONE | Insurance agents and brokers; Insurance brokerage commissions and fees; Other commissions Service code 22 | PO BOX 159 BEDFORD, IL 47421 | $0 |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 215 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 215 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | ANTHEM INSURANCE COMPANIES, INC. | 215 | $391K |
| Dental | DELTA DENTAL OF INDIANA | 215 | $77K |
| Vision | UNITEDHEALTHCARE INSURANCE COMPANY | 215 | $11K |
| Stop-loss / reinsurancereinsurance | ANTHEM INSURANCE COMPANIES, INC. | 215 | $380K |
| Other(2 contracts, 2 carriers) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 215 | $28K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 215 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.